ACL Post op Rehab

[nogero]

i blew my right acl on november 29th with minor mcl damage. i was in a leg brace until i had surgery on january 3rd to ensure my mcl was healed before surgery. i did minor exercise my doctor prescribed me for that month and saw my PT the week before my surgery to get more extension. i opted with the hamstring allograft and my doctor never had me wear a brace post-op. his theory is that this would help my knee heal on its own without the assistance of a brace and and becoming reliant on it. my pain for the first two days was very high, especially when getting up for the bathroom but i was able to manage the pain well with percocet if i took them at the rights times (very important). after a week i was comfortable moving around on my own and not needing prescription pain medication. personally i inhale the herb for those purposes. i met with my PT for two months before i "graduated". i would ride the stationary bike for ten minutes and do a leg extension sled machine, as well as stimulation, ultrasound, massage and of course lots of ice. after i graduated i got a gym membership because my hamstring still needs lots more development. at six months my doctor gave me the 100% clear to ski again he recommends a brace mainly for skiing. does anyone have anything to recommend for braces? (CTI or donjoy or ?)

it is about 8 months since my surgery and i have absolutely no complaints about my surgery or my rehab. my hamstring is still severely diminished but it keeps me honest about my personel rehab and exercise. i ride my bike everyday, have been going to the gym and running more than i've ever tried before, and have really embraced yoga. i have zero front knee pain when kneeling and am close to being able to sit on my right ankle again. my knee still aches from time to time, after adding more weight to exercises, doing too many lunges, running too much, or sometimes the weather (its weird). but it has never been emergency pain. my quad and calf are nearly back to 100%. my calf got extremely tight as well, stretching and massaging will be the best thing to loosen it up. i cannot express how much your knee, and your life, will benefit from yoga. most instructors will be able to work with and help any injury you may have. for me, and most people here obviously, skiing is the most important thing in my life right now and i need a good knee for it. so do the rehab as best you can and if done properly it can comeback as strong as before, if not stronger.

shogun - lots of pain in your calf is expected, all the blood flows that way when standing. pain will get better as swelling reduces. just some thoughts on school...i highly suggest finishing up before you leave and find your ski oasis. two winters ago i moved to tahoe to do my internship and last few classes for school online. im still in tahoe but no degree yet. lol. im currently completing them online and i really wish i never had to worry about them while living here. good luck in whatever you choose, and especially in your rehab. sounds like youre serious about it which is the most important thing.

zion - real sorry to hear about your struggles. much positive vibes your way

[Shogun]

3 weeks post-op. Got full rotation on the stationary bike and back to driving stick. Still walking with a little bit of a limp but its getting better. Can bend to just about 100 flexion. Working on my little PT exercises at home and going in twice a week. Also, calf pain is pretty much gone, now just working on getting the muscle's back there and in my quads. Each day gets slightly better...Hope everyone else is coming along smoothly in their recovery. Can't believe its only a week out from being a full month post op. Keep moving forward.

[zion zig zag]

I'm 2 weeks and 2 days post op. Still completely on crutches due to tightness in my calf, the cellulitis has almost resolved with antibiotics. I've been doing 10 minutes a day on the stationary bike and trying to stretch my calf for 10 minutes every hour. I can bend my knee to 114 degrees flexion and straighten to 5 degrees. I'm going to bump up pt to 3 times next week to try and get this calf tightness fixed, they told me if I can't loosen it soon I may need to sleep in some kind of mid-evil torture device that pulls it all night. I'll be stoked when I can walk again.

[wolfelot]

Last Friday I was officially released from PT at 11 weeks. I am getting WAAY stronger and flexed to 144 degrees last Friday. I now can get my heel to within about two inches of my butt. Tomorrow I am going to lightly jog 1/4 mile on the treadmill.

While far from 100% my improvement continues!

[doughboyshredder]

Officially released from PT does not mean stop going.

Your PT will be able to really help you get ready for the season once you're a little bit stronger. You may just have to pay out of pocket for it.

Today was a breakthrough day for me. My insurance doesn't cover PT so I worked with my therapist to come up with a plan to do most of it at home. I have done a pretty good job at sticking with it. Today I had a meeting with my PT to check on my improvement and see what more I could start doing. Stoked. I have been cleared to start jogging again, and have a written plan to ease myself back in to it. I also worked a good solid 55 minute plyo workout. God damn it felt good to be jumping up and down again. PT says there is no doubt that if I stick with our new plan that I will be solidly good to go in mid November. Bring the fucking pow La Nina!

[wolfelot]

Officially released from PT does not mean stop going.

Your PT will be able to really help you get ready for the season once you're a little bit stronger. You may just have to pay out of pocket for it.

I should clarify, the things I was doing in PT I can completely do on my own and there was not much need for someone to watch me do my exercises that I have done many times before. I'm still working out everyday, I just don't have standing appointments a few times a week. I'll check in in about 5 weeks and I can give my PT guy a call anytime with questions.

Despite being released from supervised PT I am FAR FAR from done with it.

[Cedrik]

5 months post-op next week. I just got back from my longest road bike ride in years, 55 miles. I shuttled a friend's car to Onion Valley, then rode back to Bishop. It was cold and rainy at Onion Valley, so I was soaked and frozen by Independence, but dried out riding up valley.

Last Friday my PT tested me for Return to Sport. That was a tough workout, with single leg presses to exhaustion, etc, but I'm at 80% leg strength (i.e., repaired leg 80% as strong as other leg), 100% balance and lateral action, but really weak hamstring (I did opposite leg harvest). My knees and quads are equal size.

So, the numbers allow Return to Sport, but my doc's protocol doesn't. I have a check-up next week, so I'll see what the doc says I can/should do from here on out.

[doughboyshredder]

I am a week away from 5 months and can't imagine being cleared to return to sports. You must have healed pretty quickly. Doc's protocol is probably longer because regardless of strength it takes at least 6 months for the graft to be taken 100%. (or so I've read and been told).

[Cedrik]

Yeah, I'm in no hurry. I'll keep doing my pt and following orders, which has worked for me so far. The only reason I biked so far was that seemed like the easiest way to shuttle the vehicle. Plus, if you know the terrain, it's all downhill from Onion Valley to Indy, then basically flat back home, so it was more an aerobic endurance ride than hard quad workout.

[tone capone]

Wow, my quad is still half size at 6.5 months. So much work to do before ski season. I hate the gym!

[Alpinord]

Wow, my quad is still half size at 6.5 months. So much work to do before ski season. I hate the gym!

I hear ya. The atrophy is very apparent after almost 6 months.

I just got the green light from the doc to pursue typical activities without the brace. The confidence is building that odd angles, stresses, twists and slips aren't going to destroy my life as the knee feels more and more solid.

I was told, that at 6 months the knee is around 85% of normal. This is generally considered good enough for activities. It can take anywhere from 8 to 14 months to truly get back to 100%.

One thing that dramatically helped pain early on was Arinicare arnica cream.

[doughboyshredder]

5 months now. Doc says I'm doing great. Says that my knee is solid. I haven't had any atrophy of the quad. Maybe due to the different type of surgery? (I had an allograft). Just got the prescription for my don joy braces. Getting an oa brace for the left knee and an acl brace for the right knee.
2 months and I will be ready to shred! Stoked.

[sftc]

Wow, my quad is still half size at 6.5 months. So much work to do before ski season. I hate the gym!

I'm in the same boat at just over 4 months with my left quad 3" smaller then my right, but I'm starting to see a little bit if improvement in muscle tone and I was at ~140 deg. flex and 2 deg. away from straight the other day at PT. My doc is happy with my progress because I did have a hammy graft and she said she'll clear me for "twisting sports" in 2 months if I keep progressing at the same rate.

FYI, I'm digging doing heavy cardio work on an elliptical machine as part of my PT workout because it's lower impact then running, more intense then walking, and I think it offers more of a total body workout then road biking, if you use the silly looking arm things. Plus I can catch up on the Daily Show and Colbert Report off of my laptop while doing my workout.

Couple of questions for the group:
1) Have any of you done any testosterone therapy or something similar to gain back muscle mass? I'm over 40 and I read an interesting article in Outside Magazine about a middle-aged road biker who legally 'doped' with T to see what it did and it sounded like it could be a good way to gain some back some muscle mass.

2) My doc wants me to get fitted for a sports brace and wear it for at least a year for skiing, so is a custom CTI brace still the way to go? Any other braces I should look at?

[tone capone]

I went in for my six month and told them I want a brace for skiing. They said I want a custom brace for skiing so bulk my leg up for the measrurement. The doc basically said don't bother with a brace, but he is a musclebound freak, so I know where he's comin from. (That I should be working out in the gym 8 hours a day, not gonna happen)

Right now I can tell you, I have made progress, I have been doing a ton of stuff, leg feels stronger, smarter, but no gain in size. Hiking, bikiing, almost everyday, alot. I can even say I'm close to 95% on the bike. I make it a point to really crank or step up on that leg at times. I can't bear the thought right now of a free day going by where I'm sweating indoors under flourecent lights instead of just doing what I love. I know I'll fit it in soon though in the off season, the thought of skiing on it doesn't instill confidence yet. I am just learning, you fuck up the knee, it's really truly amazing what follows in terms of muscle loss, and the way it affects other stuff, your hip, foot, calf, your "good knee" whatever, it all gets affected during the process. I'm humbled.

The last thing I need is more testosterone for sure though, I think I just gotta isolate my leg more. I have heard that if you're on opiates, if you sleep shitty, if you eat shitty, (soy) then definetly, your testosterone levels will be lower and you won't readily build muscle. In my case I have no excuse but that I can't handle the gym till full on grey and brown season.

[Alpinord]

Here is the fitted brace I paid $600 plus for because "it was the the maximum insurance would allow". It's not rocket science to fit and does stabilize the knee while allowing my 'normal' sport activities (except golf).......but as I understand it, the ACL and surgery related impacts are healed and good to go.

What are you expecting the brace to do for you? Per my surgeon and PT, not using your brace and doing thinks naturally negates 'compensations' your body makes relative to the brace. My doctor said that you can wear the brace for peace of mind the first time or two out skiing, but you don't 'need it'. I asked about variable terrain and snows and he just shrugged: "You'll be good to go..."

As stated, it takes time to fully heal and by doing the things you love to do (smartly), you will get it back, possibly better than before.

[skioride]

Seems like most of you fellows are doing great!! I had an amazing week 5 and 6. They let me start with the eliptical during week 5 and by the middle of week 6 I made it through an entire 45 minute spin class and was able to stand and bike for 2 minutes 4 separate times with absolutely no pain. Then a non bike related setback.....
I went easy on Friday and then on Saturday I got sick as HELL!!! Throwing up for the next 6 days. It's now been 10 days since I've been able to workout and I'm hoping to get back to the grind in the next day or 2. The good news is my swelling is completely down but I have absolutely no strength. I'll start back slow but I should come along quickly. GL

[skioride]

One last thing. I had same patella surgery and I'm beginning to be able to kneel. I don't think I'll have the pain problem some of you have had long term on the patella.

[doughboyshredder]

Here is the fitted brace I paid $600 plus for because "it was the the maximum insurance would allow". It's not rocket science to fit and does stabilize the knee while allowing my 'normal' sport activities (except golf).......but as I understand it, the ACL and surgery related impacts are healed and good to go.

What are you expecting the brace to do for you? Per my surgeon and PT, not using your brace and doing thinks naturally negates 'compensations' your body makes relative to the brace. My doctor said that you can wear the brace for peace of mind the first time or two out skiing, but you don't 'need it'. I asked about variable terrain and snows and he just shrugged: "You'll be good to go..."

As stated, it takes time to fully heal and by doing the things you love to do (smartly), you will get it back, possibly better than before.

funny, my PT who deals with a lot of skiers and snowboarders and my doc who is a skier, says a brace while snowboarding or skiing is a must. I just got fitted for a don joy on Friday. Are you a super aggressive skier? One thing I've found is that some docs and therapist really don't understand when we tell them that we are experts and that we ski or ride aggressively. Weekend groomer skiers have no idea what goes on during a midweek pow slaughter on the upper slopes.

[zion zig zag]

funny, my PT who deals with a lot of skiers and snowboarders and my doc who is a skier, says a brace while snowboarding or skiing is a must. I just got fitted for a don joy on Friday. Are you a super aggressive skier? One thing I've found is that some docs and therapist really don't understand when we tell them that we are experts and that we ski or ride aggressively. Weekend groomer skiers have no idea what goes on during a midweek pow slaughter on the upper slopes.

My Doc has known me as a skier for years, and is the US Ski team doc and he says a brace is not needed, he said he used to prescribe them but quit several years ago. He says once he clears for for all activities my knee new will be stronger that it was before. I'll ask again but that's the story I've gotten.

In other news, I'm at week 4 on this coming Tuesday and I'm just now starting to walk very slowly with one crutch. The cellulitis really set me back, the swelling and redness are mostly gone but my calf is still tight and limiting my ankle movement to about 50 %. I can tell I'm making progress, but it is slow. My knee is pretty much on track for range of motion (140*) but strength is down due to the inability to bear weight.

[doughboyshredder]

It's interesting how different surgeons and therapists can have completely different opinions on this stuff.

[wolfelot]

I totally agree. I is interesting to see the different approach physicians take:

It's interesting how different surgeons and therapists can have completely different opinions on this stuff.

I'm heading to the gym shortly. My ROM continues to get smoother than it has been. My heel is getting to about 2.5 inches of my butt and the stiffness in the last 20 degrees continues to diminish. Today I am going to jog .46 miles on the treadmill in addition to my other workout exercises. I continue to make gains in the amount of weight I'm lifting and calories burned during cardio.

[Alpinord]

funny, my PT who deals with a lot of skiers and snowboarders and my doc who is a skier, says a brace while snowboarding or skiing is a must. I just got fitted for a don joy on Friday. Are you a super aggressive skier? One thing I've found is that some docs and therapist really don't understand when we tell them that we are experts and that we ski or ride aggressively. Weekend groomer skiers have no idea what goes on during a midweek pow slaughter on the upper slopes.

In our area there are a lot of orthopedic options and as far as I can tell, many are influenced by Vails' Steadman Clinic, including my surgeon:

Dr. Lawton completed a fellowship at the Steadman-Hawkins Clinic in Vail, Colorado, where he specialized in shoulder and knee reconstruction and sports medicine. He is one of only three doctors in the world who has trained at both the Mayo Clinic and Steadman-Hawkins. The Steadman-Hawkins Clinic is regarded as one of the world’s top sports medicine clinics, treating World Cup soccer players and athletes from the NFL, NBA, U.S. Ski Team and Major League Baseball. During his time at this world-renowned clinic, Dr. Lawton was the assistant team physician for the Super Bowl Champion Denver Broncos' and Colorado Rockies.

I'm becoming a believer the more I 'challenge' the knee and do normal activities.....normally. Yesterday, we hiked 1700 vert, mostly in snow (to the crash site) without a concern about slipping in the mud and slop. Today, while golfing, cranked several long drives and the twisting action had no effect. I'm psyched.

Listen to what your PTs and doctors are telling you, but don't be afraid to challenge them or ask for other opinions if you have concerns. It's your body and life, not theirs.....and listen to what your body is telling you.

[zion zig zag]

More complications, lymph-edema, back in a compression sock. 5 weeks post op and I'm using one crutch with a serious limp.

[kingdom-tele]

3z - ask around your rehab setting for a therapist who can perform manual lymph drainage, its a specific mobilization that will help drain your leg, they will also get you the correct compression (graded vs uniform) it will save you a huge chunk of time fighting the auto response from your body

[HowieT2]

just found this thread and it prompted me to register at tgr.

im 43 and tore my left acl on 3/20/11. Surgery with allograft on 5/3 so I am almost 5 months post op. Surgeon discharged me last week, so I think im doing ok. But a friends son ruptured his acl yesterday about a year after having it reconstructed as did Giant WR Hixon on sunday. so I'm nervous that I'm kidding myself thinking I'm all right.

I did pt and biking before the surgery and believe that helped significantly. Fwiw, I didn't have any pain when it happened and other than the day of the surgery, not much since. I rode a stationary bike 5x/week for 20-30 minutes from 3 days post op for two months. I got a "lenox Hill" custom brace and have been riding my mtn bike 2-3x/week since. I ride clipped in and havent experienced any problems so I ditched the brace in favor of a neoprene sleeve. I've done a few days of real downhill mtn biking, again without difficulty. Where I ride regularly the trails are pretty technical and while I've taken it easy, the knee has been fine. my only issue is minor swelling and weakness if I go more than 2-3 days without biking.

I stopped formal PT after 2 months but Im thinking of going back to do some skiing specific routines.